Provider Demographics
NPI:1437250289
Name:KUPETZ, SERGE (DDS)
Entity Type:Individual
Prefix:
First Name:SERGE
Middle Name:
Last Name:KUPETZ
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4840 W PANTHER CREEK DR STE 211
Mailing Address - Street 2:
Mailing Address - City:SPRING
Mailing Address - State:TX
Mailing Address - Zip Code:77381-3542
Mailing Address - Country:US
Mailing Address - Phone:832-791-5550
Mailing Address - Fax:718-462-2418
Practice Address - Street 1:4840 W PANTHER CREEK DR STE 211
Practice Address - Street 2:
Practice Address - City:SPRING
Practice Address - State:TX
Practice Address - Zip Code:77381-3542
Practice Address - Country:US
Practice Address - Phone:832-791-5550
Practice Address - Fax:718-462-2418
Is Sole Proprietor?:No
Enumeration Date:2006-09-26
Last Update Date:2021-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX30605122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02119991Medicaid